Clinical Procedure for

Medical Assistant 2
Learning Outcomes

 Identify the instruments used to measure vital signs,

urine and blood sugar testing.

 Explain the procedure for performing vital signs.

Vital Signs

 Vital signs are usually done immediately before the

doctor examines the patient
 They provide the doctor with information about the
patient’s overall condition
 It helps the doctor to make a diagnosis.
General Considerations

 Vital signs are the primary indicators of a patient’s

overall general condition. The vital signs are as follows:
 Pulse
 Blood Pressure
 Oxygen Saturation
 Respiration
 Temperature
Adult Vital Signs and
Values……
VITAL SIGNS NORMAL VALUES IN ADULTS

Temperature NORMAL 36.5-37.5 (> 37.5 or

38.3 FEVER )

Pulse 60-85 beats/min

Blood Pressure 120/80mmHg

Respiratory Rate 12-16 breaths per min

Oxygen Saturation 95-100%

Pulse and Respiration

 Pulse is your heart rate.

 Respiration is your breathing. It is a measured as the
number of times a patient breathes in 1 minute.
 One breath or respiration equals one inhalation and one
exhalation.
 Usually if either the pulse or respiration rate is high or
low, the other is also.
 The usual ratio of pulse rate to the respiration rate is
about 4:1
Pulse

 A pulse rate gives information about the patient’s

cardiovascular system. It is an indirect measurement of
the patient’s cardiac output.
 It the pulse is abnormally fast, slow, weak or irregular,
the patient may have a medical problem.
 Measure the pulse of adults at the radial artery, where
it can be felt in the groove of the thumb side of the
inner wrist.
Pulse continued

 Pressing lightly on this pulse point and counting the

number of beats you feel in 1 minute will yield an
accurate pulse.
 Office policy may direct that you count the pulse for 30
seconds and multiply the results by 2 to obtains beats
per minute.
 If you take the pulse for less than 1 minute and notice
irregularities, you must count for 1 full minute and
document the irregularities.
Pulse continued

 In young children, the radial artery may be hard to feel.

You may instead take the pulse at the brachial artery,
which is in the bend of the elbow (antecubital space).
 A normal adult pulse rate is 60-100 beats per minute
Procedure for taking pulse

 Using the first and second fingertips, press firmly but

gently on the arteries until you feel a pulse.
 Begin counting the pulse when the clock's second hand
is on the 12.
 Count your pulse for 60 seconds (or for 15 seconds and
then multiply by four to calculate beats per minute).
 When counting, do not watch the clock continuously,
but concentrate on the beats of the pulse.
 If unsure about your results, ask another person to
count for you.
Let’s watch a……
Blood pressure (1)

 The standard unit for measuring blood pressure is

millimeters per mercury (mmHg)
 The pressure measured when the heart contracts is
known as the systolic pressure
 The pressure measured when the heart relaxes is known
as the diastolic pressure
 Adults systolic pressure normally range from 90 to 140
mm Hg, but these values increases with advancing age.
 Diastolic pressures normally range from 60 to 90 mmHg.
Blood Pressure

 Blood pressure is the force of the blood pushing against

the artery walls during contraction and relaxation of the
heart.
 Each time the heart beats, it pumps blood into the
arteries, resulting in the highest blood pressure as the
heart contracts.
 When the heart relaxes, the blood pressure falls.
Blood Pressure continues

 Certain disease states may cause blood pressure to rise

above or fall below these ranges.
 Thus it is important to recognize these abnormalities.
Hypertension or high blood pressure is a major
contributor to heart attack and stroke.
 Blood pressure is measured with an instrument called a
sphygmomanometer.
Blood Pressure continues

 A sphygmomanometer consists of an inflatable cuff, a

pressure bulb for inflating the cuff and a device
(manometer) to read the pressure.
Sphygmomanometer
Taking blood pressure

 Sites for Measuring blood pressure

 Upper arm ( using Brachial artery-commonest)
 Thigh (around the popliteal artery)
 Fore arm (using radial artery)
 Leg (using posterior tibial or dorsal
pedis)
Taking a Blood Pressure

 Wrap the cuff around the arm

 Inflate the cuff with the pressure bulb to about
160mmHg for adults
 Slowly release the pressure until your hear the first
sound –Systolic Pressure
 Gradually release the pressure, until you don’t hear a
sound- Diastolic Pressure.
Blood Pressure values

 Blood pressure is categorized as normal, elevated, or

stage 1 or stage 2 high blood pressure:
 Normal blood pressure is systolic of less than 120 and
diastolic of less than 80 (120/80)
 Elevated blood pressure is systolic of 120 to
129 and diastolic less than 80
 Stage 1 high blood pressure is systolic is 130 to
139 or diastolic between 80 to 89
 Stage 2 high blood pressure is when systolic is 140 or
higher or the diastolic is 90 or higher
Next Video…..
Oxygen Saturation

 Oxygen saturation is the fraction of oxygen in the

blood. The human body requires and regulates a
very precise and specific balance of oxygen in the
blood.
 . Normal pulse oximeter readings usually range
from 95 to 100 percent. Values under 90 percent
are considered low
PULSE OXIMETER
Respiration

 Respiration rate indicates how well a patient’s body is

providing oxygen to tissues.
 The best way to check respiration is by watching the
movement at the patient’s chest, stomach, back or
shoulders.
 If you cannot see the chest movements, then listen for
the patient’s breathing.
Respiration continues
 Counting respirations for less than 1 full minute may cause you to miss
certain breathing abnormalities. Irregularities such as dyspnea (difficulty
or painful breathing), tachypnea (rapid breathing), or hyperpnea (deep,
rapid breathing) are important indicators of possible infection or disease.
 Respiration rates are higher in infants and children than adults. Become
familiar with normal respiration for each age group.
 A normal adult respiration is 12-20 breathes per minutes.
Let’s watch a Video
Temperature

 When you take a patient’s temperature, you will

determine if the patient is febrile (has a body
temperature above the patient’s normal range) or
whether the patient is afebrile (has a body
temperature at about the a patient’s normal
range)
 A fever is usually a sign of inflammation or
infection.
 Temperature can be taken Central or Peripheral
Central or Periperal

CENTRAL PERIPHERAL
 Mouth  Wrist
 Rectum  Forehead
 Armpit
 Ear
Temp continued

 Temperature can be measured in degrees or

Farenheit
 Normal adult oral temperature is considered to be
between 37.0 degrees celsius
 Rectal and tympanic temperatures are normally 1
degree higher than oral temperatures (inside the
body)
 When used properly, the rectal and oral methods
usually provide the most accurate temperatures.
Temp continues

 Peripheral temperatures are normally 1 degree

lower than oral temperatures because the area is
outside the body and exposed to air.
 Temperature is measured with a thermometer.
Thermometers may be of three types: mercury,
electronic, digital or disposable.
 The most commonly used site in health care is the
axillary.
Mercury Thermometers

 A mercury thermometer is a thin glass tube with a

mercury filled bulb at the end.
 The mercury expands and rises in the tube as the
temperature rises.
 The glass tube is marked for reading the
temperatures in degrees or Farenheit.
 The bulb of a mercury thermometer varies in
shape with its purpose.
Thermometers
How to take a Temperature…….
(Watch a Video).
Taking temperatures

 Using the proper instrument and technique

provides the most accurate temperature readings.
 Thus you must be sure to indicate the site (oral,
rectal, axillary, tympanic ) of the temperature
measurement when you enter the reading in the
patient’s chart.
Using mercury thermometers

 Before you use a mercury thermometer, you must shake

the mercury down.
 Holding the thermometer securely at the end opposite
the insertion tip, use a snap of the wrist to shake the
mercury down below 35 degrees celsius.
 If you break a thermometer, clean up the spill quickly.
Put on a rubber gloves, and use two pieces of stiff
paper to scoop up the mercury. Put it in a biohazard
waste container. Then use a damp cloth or paper
towels to clean up the pieces of broken glass.
 Place the glass shards and cloth or towels in a
biohazardous waste container.
Temperature values

 Babies and children. In babies and children, the

average body temperature ranges from 97.9°F (36.6°C)
to 99°F (37.2°C).
 Adults. Among adults, the average body temperature
ranges from 97°F (36.1°C) to 99°F (37.8°C).
 Adults over age 65. In older adults, the average body
temperature is lower than 98.6°F (36.2°C).
Conversion

To Convert Degrees Celsius to Farenheit

EXAMPLE:
To convert 37 degree Celsius to Farenheit
(37 x9/5) + 32
66.6 + 32=98.6 F
 CONSTANT
- Degrees Celsius.
OTHER TESTS…………..
URINE TEST

 The urine can contain many different clues to how your

body is doing. Your urine tells a lot about your health.
Testing the urine is known as “urinalysis” (analysis of
the urine). 
 The results of urine tests can be affected by diet,
dehydration, medicines, exercise, and other factors.
Sometimes, you will be asked to come back and give
another sample.
OTHER TESTS……

Urine Blood Sugar Test

 Kidney disease- Proteins  Diabetic
 Infections- Blood, smell
bad and looks cloudy
 Diabetic- Ketones
 Dehydration-
concentrated, dark and
yellow
 Pregnancy
Further Reading

 https://meded.ucsd.edu/clinicalmed/vital.html